Sporadic cases of chikungunya, R

eunion Island, August

2009.
E. DOrtenzio, M. Grandadam, E. Balleydier, J. S. Dehecq, M. C.
Jaffar-Bandjee, A. Michault, S. F. Andriamandimby, J.-M. Reynes, L. Filleul

To cite this version:

E. DOrtenzio, M. Grandadam, E. Balleydier, J. S. Dehecq, M. C. Jaffar-Bandjee, et al.. Sporadic cases of chikungunya, Reunion Island, August 2009.. Euro surveillance : bulletin europeen
sur les maladies transmissibles = European communicable disease bulletin, 2009, 14 (35), epub
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R a p i d c o m m u n i c a ti o n s

Sporadic cases
Aug ust 2009

o f c h i k u n g u n ya ,

Runion Island,

E DOrtenzio (ericdortenzio@gmail.com)1, M Grandadam2, E Balleydier1, J S Dehecq3, M C Jaffar-Bandjee4, A Michault5, S F

Andriamandimby6, J M Reynes6, L Filleul1
1. Regional office of the French Institute for Public Health Surveillance, Institut de Veille Sanitaire, Runion, France
2. National Reference Centre for Arboviruses, World Health Organization Collaborating Centre for Arboviruses, Institut Pasteur,
Paris, France
3. Vector control team, Regional office for sanitary and social services (DRASS), Runion, France
4. Microbiolog y Laboratory, Regional Hospital Centre of Saint-Denis, Runion, France
5. Laboratory for Bacteriolog y, Parasitolog y, Virolog y and Hospital Hygiene, Regional Hospital Centre of Saint-Pierre,
Runion, France
6. Virolog y Unit, Institut Pasteur, Antananarivo, Madagscar
This article was published on 3 September 2009.
Citation style for this article: DOrtenzio E, Grandadam M, Balleydier E, Dehecq JS, Jaffar-Bandjee MC, Michault A, Andriamandimby SF, Reynes JM, Filleul L. Sporadic cases of
chikungunya, Runion Island, August 2009. Euro Surveill. 2009;14(35):pii=19324. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19324

On 28 August 2009, French authorities reported five cases of

chikungunya fever on Runion Island: three confirmed, one
probable, and one suspected case under investigation. All three
confirmed patients presented with an acute febrile syndrome,
arthralgia, myalgia and cutaneaous rash. All live in the same area
on the western side of the island.
Introduction
In 2005-2006 a major epidemic of chikungunya virus (CHIKV)
infections occurred on Runion Island [1] and in the southwestern
Indian Ocean region [2]. In Runion, the cumulative attack rate
was 36% [1] and corresponded to the seroprevalence rate of
38% that was measured at the end of the epidemic [3]. After
December 2006, no new autochthonous confirmed case of CHIKV
was detected on Runion Island [4].
On the neighbouring island of Madagascar, chikungunya
virus was responsible for a large outbreak in 2006 in Toamasina
(Tamatave), a coastal town located 350 km northeast from the
capital Antananarivo. Within 4,242 randomly selected patients
over near 200 000 dengue like syndromes reported among
representative residents, 67,5% were found positive for a recent
Chikungunya infection [5]. Further outbreaks of chikungunya fever
occurred in May 2006 in Mahajanga (northwest coast), in February
2007 in the Sava region (northeast coast), in March to June 2007
in Antsiranana (northern coast), with 20 (29 sampled), 10 (15
sampled) and 14 (28 sampled) confirmed cases, respectively
[6]. Since March 2009, the sentinel surveillance network of the
Malagasy Ministry of Health has reported sporadic confirmed cases
in Toamasina [6]. In June 2009 viraemic cases imported from
Madagascar (Toamasina) to continental France were documented
[6].
Cases of chikungunya on Runion Island in 2009
On 5 April 2009 a Malagasy patient travelled for a medical
visit from Madagascar to Runion where he developed symptoms
typical of chikungunya fever. A blood sample on 10 April 2009

was positive for CHIKV by specific anti-CHIKV IgM and by real

time RT-PCR [6,7].
An autochthonous confirmed case of chikungunya fever was
reported to the regional office of the French Institute for Public
Health Surveillance in Runion (Cire Runion-Mayotte, Institut de
Veille Sanitaire) in August 2009 by the Pasteur Cerba laboratory.
The Pasteur Cerba laboratory is a central laboratory that receives
specimens (on average 3,500 specimens per month) from all over
the country including the French overseas territories (West Indies,
Guyana, Polynesia). This autochthonous confirmed case lives in
Saint-Gilles-Les-Bains on the western side of the island. On 18
July 2009, she had presented with an acute febrile syndrome
associated with arthralgia, myalgia, and a cutaneous rash. A blood
sample, drawn on 24 July 2009 was found positive for specific
anti-CHIKV IgM but negative for IgG and in the RT-PCR. The case
was confirmed at the National Reference Centre for Arboviruses at
the Institut Pasteur in Paris by detection of anti-CHIKV IgG in a
second blood sample taken on 11 August 2009.
Two further autochthonous cases of CHIKV infection in people
from the same town were diagnosed at two local hospitals. Both
patients reported an acute febrile syndrome associated with
arthralgia, myalgia, and cutaneous rash on 23 July and 3 August
2009, respectively. The first one was found positive for CHIKV by
RT-PCR and the second by seroconversion demonstrated on paired
sera. All results were confirmed by the National Reference Centre
for Arboviruses at the Institut Pasteur in Paris.
None of these three confirmed cases of chikungunya virus
infection reported a recent travel history off the island or a contact
with persons with a travel history or having received a package
from abroad.
Currently two other probable cases are being investigated: a
tourist who reported an acute febrile syndrome associated with
arthralgia and cutaneous rash on 4 August 2009 and had stayed
in the same area as the confirmed cases and a permanent resident

E U R O S U R V E I L L A N C E Vol . 14 I ss u e 35 3 Se p t e mb e r 20 0 9 w w w. e u ro s u rve i ll an c e . o rg

of Saint-Paul, a neighbouring town of Saint-Gilles-Les-Bains who

had reported a stay in Saint-Gilles-Les-Bains.
Sequence analysis is in progress at the National Reference
Centre for Arboviruses at the Institut Pasteur in Paris to tentatively
determine the origin of the chikungunya virus in order to establish
whether the2005-2006 Runion strain has re-emerged or whether
a new isolate has been introduced.

6. ProMED-mail archive no. 20090611.2156. Available from: http://www.promedmail.

org/pls/otn/f?p=2400:1001:735112850628827::::F2400_P1001_BACK_PAGE,F2400_
P1001_ARCHIVE_NUMBER,F2400_ P1001_USE_ARCHIVE:1001,20090611.2156,Y
7.

Cire Runion-Mayotte. Chikungunya Madagascar et en Asie du sudest et suspicion de dengue Maurice Point pidmio n37 au 16/06/2009.
Available from : http://www.reunion.sante.gouv.fr/epidemiologie/PE-CHIKDENGUE-17-06-09.pdf

Conclusion
Epidemiological and biological investigation of theses cases
provides evidence for active transmission of chikungunya virus in
Saint-Gilles-Les-Bains, a tourist location on Runion Island. In
reponse to this outbreak, control measures are being organised by
the Cire Runion-Mayotte and the Vector Control Team of Drass
Runion. Active mosquito control measures and information to
the population on how to prevent mosquito bites have rapidly been
implemented.
Entomologic investigation found low vector activity correlated to
winter in the southern hemisphere. Nevertheless, mosquito density
seems to be sufficient to support CHIKV transmission. The current
austral winter may contribute to moderate the transmission, but
special attention in the next weeks is needed. Reinforcement of
epidemiological and entomological surveillance has been organised
to prevent the risk of potential spread of the virus on the island.
Medical staff on the island has been informed about the situation
and recommendations on how to react to suspected cases have
been issued to them.
Currently, health services in Runion are under intense strain
because of the current H1N1 influenza pandemic. However,
despite the small number of cases of CHIKV infection, special
attention should be focused on arbovirus activity to prevent, or at
least minimise, the spread of the virus during next summer in the
southern hemisphere starting in November. Physicians should be
aware to sample patients for chikungunya infection when facing a
patient presenting an influenza-like syndrome without respiratory
symptoms. The Runion-Continental France laboratory network,
built up in 2005 to support local laboratories confronted with the
emergence of Chikungunya virus, has been reactivated to reinforce
diagnostic capabilities. Specific information of persons living in
the area or visiting this island, focusing on individual mosquito
bite prevention, should be intensified both locally and in northern
hemisphere countries.

Refe re nces
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Chikungunya prevalence in La Runion Island outbreak by serosurveys: two
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